What is a cesarean scar pregnancy?

The uterus after a cesarean section is what we call a scarred uterus. A cesarean scar pregnancy occurs when an embryo is implanted into the incision of a previous cesarean section. During the implantation of the placental villi into the muscle layer, the scar on the layer is easily torn, which will cause uncontrollable hemorrhaging and even uterine ruptures. This is life-threatening, so the uterus must be removed.

The incision scar cannot provide enough nutrition for the fetus, so women with a cesarean scar pregnancy will usually have massive hemorrhaging within three months. In this case, not only will the second baby be lost, but the mother will have intra-abdominal hemorrhaging and shock, and may even lose her life. Therefore, cesarean scar pregnancies must be avoided. If a pregnant mother discovers an early pregnancy, she must go to the hospital for a B-ultrasound diagnosis as soon as possible; and if diagnosed with a cesarean scar pregnancy, she must be hospitalized immediately.

Clinical manifestations of a cesarean scar pregnancy

The clinical manifestations of a cesarean scar pregnancy are not specific. All patients have a history of cesarean section, a history of menolipsis, an enlarged uterus, elevated blood HCG (human chorionic gonadotropin) and other normal early pregnancy manifestations.

How is a cesarean scar pregnancy diagnosed?

Ultrasonography is the first choice, especially the combined use of transvaginal and transabdominal ultrasounds, which can not only help locate the gestational sac, but also help clarify the relationship between the gestational sac and the lower muscle layer of the anterior uterine wall and the bladder.

How is a cesarean scar pregnancy treated?

Once diagnosed with a cesarean scar pregnancy, the pregnancy should be terminated immediately, the pregnancy tissue should be removed as soon as possible, and the reproductive function should be preserved as much as possible. Operative treatment focuses on removing lesions and controlling bleeding.

1. Drug therapy: This is not the first choice for clinical treatment. It is suitable for patients with a cesarean scar pregnancy in the first trimester who are unwilling or unsuitable for operative treatment. Drug therapy alone has poor results, and operative treatment is often required. If pregnancy tissue is discharged following the medication, and there is not much bleeding and no residue after the re-examination, an operation cannot be performed.

2. Uterine artery embolization: This is mainly used as adjuvant therapy. Operative treatment after uterine artery embolization can reduce intraoperative bleeding, but for patients with fertility needs, uterine artery embolization may cause ovarian function decline and other consequences, which may affect women's subsequent fertility. Therefore, patients who wish to keep their fertility are encouraged to choose other methods.

3. Operation: Operation is the best treatment method for a cesarean scar pregnancy.

(1) Hysteroscopic diagnosis and treatment: This is a commonly used clinical operative method resulting in minimal trauma and quick postoperative recovery and it preserves reproductive function. It is suitable for patients whose muscle layer has a certain level of thickness.

(2) Laparoscopic surgery: This method allows the scar to be repaired amid the termination of pregnancy. It is suitable for patients who have a thin muscle layer at the scar and wish to have children in the future. However, strict contraception is required for two years after surgery, and the scar may have a poor prognosis with diverticulitis.

(3) Hysterectomy: This is suitable when a patient's life is in danger or when a patient has no desire to reproduce in the future. A laparotomy or laparoscopic surgery can also be performed.

4. If vaginal bleeding or abdominal pain occurs during pregnancy, the patient should go to the hospital immediately.

In recent years, the General Gynecology Department of the Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), or CQHCWC, has completed more than 1,000 cesarean scar pregnancy operations under a hysteroscopy, with a success rate of over 98 percent. With little trauma and quick postoperative recovery, patients can undergo pregnancy again after just three months.

Address: Expert clinics at Area C, 4th Floor, or at Area B, 3rd Floor, Outpatient Clinic, Ranjiaba Branch of the CQHCWC

Tel: 023-60354521; 023-60354522